Date of Award

Fall 9-13-2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Cecelia Grindel

Second Advisor

Martha Polovich

Third Advisor

Elisabeth Burgess

Abstract

ABSTRACT

NURSE ENGAGEMENT IN END-OF-LIFE DISCUSSIONS

WITH DYING PATIENTS AND THEIR FAMILIES

by

FRANCES GOMES MARTHONE

Nurse engagement in end-of-life (EOL) conversations with terminally ill patients and their families is a crucial part of EOL care. However, research about nurses’ attitudes about care of dying patients, their preparation to provide that care, and their perceived self-efficacy in engaging in EOL discussions is limited. The purpose of this descriptive correlational study was to a) assess medical-surgical nurses’ self-efficacy for conducting EOL discussions and b) examine the relationships between mastery of experiences (experiences with death and dying, nursing education, years in specialty practice, and education about death, dying and EOL care), vicarious experiences (observational experiences), psychological state (attitudes about caring for dying patients and families, attitudes about death and dying, religious beliefs, professional responsibility), social persuasion (influences of mentors/coaches, nursing leadership expectations), self-efficacy, and nurse behaviors for conducting EOL discussions.

A total of 168 nurses from two hospital systems completed an online survey. Participants were primarily white/non-Hispanic (n=129; 77%) females (n=153; 91%) with a mean age of 45.1 years. These nurses averaged 11.5 years in nursing practice; half the nurses (50%) had an Associate’s Degree.

The constructs of Psychological State (R2 =20.08%; p=2=13.19%; p=2=20.93%; p=2= 36.5; p=2=20.93; p=.0001). Nurses with a high degree of self-efficacy reported a more positive Psychological State (AUC=0.748; p

These findings suggest that nurses’ psychological state is the predominant factor in nurses’ engagement in EOL discussions with dying patients and their families. Also nurses’ personal attitudes about death and dying are pivotal to engaging these patients in EOL discussions. Future research is needed to test educational interventions that will better prepare nurses to conduct EOL discussions with dying patients and their families.

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